chronic illness lisa b. flatt, rn, msn, chpn. chronic illness chronicity – last indefinitely...
TRANSCRIPT
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Chronic IllnessChronic Illness
Lisa B. Flatt, RN, MSN, CHPNLisa B. Flatt, RN, MSN, CHPN
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Chronic IllnessChronic Illness
• Chronicity – last indefinitely
• Medical care – treating symptoms vs. curing
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ModelsModels
• Chronic Illness Trajectory Model– Pretrajectory phase – wellness– Trajectory phase – onset of symptoms– Stable phase – start treatment– Unstable phase – changes in treatment/decrease in
improvement or management– Acute phase – Sick hospital– Crisis phase – life-threatening– Comeback phase – get a little better– Downward phase – moving towards death– Dying phase – actively dying
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Chronic vs. AcuteChronic vs. Acute
• Chronic – lasting
• Acute – short term with end in sight
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Adjustment PatternsAdjustment Patterns
• Kubler Ross – stages -- LOOK IT UP
• Change lifestyle
• Change location/environment
• Acceptance of limitations
• Modifications
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DisabilityDisability
• Limitations
• Face discrimination
• Limitations at home and work
• ADA of 1990 protection
• Deal with environmental conditions that we don’t think about - curbs
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Chronic Illness IssuesChronic Illness Issues
• Self-care – ADL assistance
• Deterioration of Health – progressively grow worse – ie. COPD
• Quality of life – decreases, increased problems – such as financial, depression
• Caregiver Dimension – family steps in – if there is one – dramatic changes in family life and dynamics
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Factors Influencing AdjustmentFactors Influencing Adjustment
• Gender roles – caregiver is male or female• Age – is there a spouse/SO still there, adult
children• Age – ability to continue with their disability• Preferences – who they want to help –
relationship with their HCP’s• Spiritual/religious/cultural beliefs• Support• Physical condition at start• Role insufficiency- loss of job, changes
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AssumptionsAssumptions
• People want to return to their previous state
• Intrarole conflict – inability of client to meet new demands of new role
• Interrole conflict – cannot perform expected or previous role
• Hiding symptoms are normal
• “Want to pass”
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And more…And more…
• Culture – Chinese (oldest male cares for parents) Middle Eastern – women caregivers hard to be sick and step down Different rituals
• Some cultures remove from society
• Different interpretations of quality of life
• Response to chronic illness and why you became ill in the first place
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And more….And more….
• Socioeconomic factors– Unemployment– Cost– Health insurance or lack of– Food and healthy eating
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And more….And more….
• Environmental factors– Structural– Transportation– Occupational hazards– Safety issues– Patient safety needed equipment/lifts
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PsychologicalPsychological
• Depression• Anger• Isolative• Stigma to be ill• Dependence• Clingy• Want to be normal• Learned helplessness
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Review…Review…
• Alternative and complementary therapies
• Right to Health Care
• ??What kind of and how good is it???
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Model of Chronic IllnessModel of Chronic Illness
• 133 million Americans have a chronic illness
• This number will increase 1% a year until 2030
• CDC – CV disease, cancer, diabetes
• Medicare/medicaid/private insurance/HMO
• Ethical and legal implications – Patient advocate
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Developmental Disabilties ActsDevelopmental Disabilties Acts
• 1975 – mental disorders
• 1980- advocacy program
• OBRA (omnibus reconciliation act) 1990 – right to refuse treatment
• PSDA (patient self determination act) 1991 – inform of rights and have signed papers
• Advanced and DNR
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Nursing ProcessNursing Process
• Assessment – adl’s; advocacy; ethical and legal aspect
• Analysis – collaboration, establish diagnosis and goals
• Planning – plan short term realistic goals for illness “caregiver will state plan for respite”
• Implementation – intervene for person, simple measures
• Evaluation – effectiveness of interventions determine further needs